Histopathology Curriculum Ar

8/12/2019 Histopathology Curriculum Ar

1/123

Curriculum for specialty training in

histopathology

June 2010

The Royal College of PathologistsPathology: the science behind the cure


2/123

The Royal College of Pathologists, Histopathology Curriculum Page 1

Unique documentnumber

G051

Document name Curriculum for specialty training in histopathology

Version number 4

Produced by Joint Committee on Pathology Training

Date active June 2010

Date for review June 2012

Comments In accordance with the Colleges publications policy, the original version of this document was placed on the Fellows andMembers area of the College website for consultation from 16 to 27 November 2009. A total of 71 responses weresubmitted. The authors considered the feedback and amended the document accordingly. Please [email protected] you wish to see the authors responses to the feedback.

This version has had major amendments made as a result of suggestions from the CATT, changes to the Colleges Royal

Charter and changes to the Colleges house style.

Dr Peter CowlingDirector of Communications

Joint Committee on Pathology Training

The Royal College of Pathologists

2 Carlton House Terrace

London, SW1Y 5AF

Telephone: 020 7451 6700

Email: [email protected]

Website: www.rcpath.org/education

The Royal College of Pathologists, 2010
mailto:[email protected]:[email protected]:[email protected]:[email protected]://www.rcpath.org/educationhttp://www.rcpath.org/educationhttp://www.rcpath.org/educationmailto:[email protected]:[email protected]


3/123


CONTENTS

Introduction ............................................................................................................................................................................................ 4

Entry requirements ....................................................................................................................................................................... 5

Duration of training ....................................................................................................................................................................... 5

Subspecialty training in cytopathology .......................................................................................................................................... 5

Stages of training and learning ..................................................................................................................................................... 6

Optional training .................................................................................................................................................................................... 12

Training regulations ...................................................................................................................................................................... 16

Less than full-time training ............................................................................................................................................................ 16

Research ...................................................................................................................................................................................... 16

Academic trainees ........................................................................................................................................................................ 17

Overseas training ......................................................................................................................................................................... 17

Rationale ................................................................................................................................................................................................ 18

Purpose of the curriculum ............................................................................................................................................................. 18

Curriculum development ............................................................................................................................................................... 19

Content of learning ................................................................................................................................................................................ 19

Purpose of assessment ................................................................................................................................................................ 21

Methods of assessment ................................................................................................................................................................ 21

Evidence of competence .............................................................................................................................................................. 22

Models of learning ................................................................................................................................................................................. 22

Learning experiences ............................................................................................................................................................................ 23

Supervision and feedback ..................................................................................................................................................................... 24


4/123


Managing curriculum implementation .................................................................................................................................................. 25

Curriculum review and updating .......................................................................................................................................................... 26

Equality and diversity ............................................................................................................................................................................ 26

Acknowledgements ............................................................................................................................................................................... 27

APPENDIX 1 General histopathology curriculum ........................................................................................................................ 28

Expected training during stage A / ST1 OF TRAINING .......................................................................................... 28

Curriculum content for stages BD / ST26 ........................................................................................................... 42

APPENDIX 2 Cytopathology subspecialty curriculum ................................................................................................................. 85

APPENDIX 3 Optional training packages ...................................................................................................................................... 89

APPENDIX 4 Illustrative timetable of histopathology training .................................................................................................... 110

APPENDIX 5 Acronyms .................................................................................................................................................................. 111

APPENDIX 6 Directed workplace-based assessment by stages of training and optional packages........................................ 113

APPENDIX 7 Good medical practice ............................................................................................................................................. 122

Website: www.rcpath.org/education

The Royal College of Pathologists, 2010
http://www.rcpath.org/educationhttp://www.rcpath.org/educationhttp://www.rcpath.org/education


5/123


INTRODUCTION

Histopathology in the UK encompasses surgical pathology, autopsy and cytopathology. Cytopathology may also be practised independently as arecognised subspecialty. Forensic pathology, neuropathology and paediatric pathology are related specialties (CCT-status currently being applied for)usually requiring a component of basic histopathology training.

The award of the Certificate of Completion of Training (CCT) or the Certificate of Eligibility for Specialist Registration (CESR) through the Combined

Programme (CP) route will require evidence of satisfactory completion of training in both Good Medical Practice and the core aspects ofhistopathology, which are outlined in this curriculum. Doctors who are applying for entry to the Specialist Register via the award of a Certificate ofEligibility for Specialist Registration (CESR) will be evaluated against the Good Medical Practice and core aspects of the curriculum.

The curriculum and assessment system meets the Postgraduate Medical Education and Training Boards (PMETB) Standards for Curricula and

Assessment Systems (July 2008). In addition, the curriculum complies with the training framework described at

www.mmc.nhs.uk/specialty_training_2010/gold_guide.aspx(A Reference Guide for Postgraduate Specialty Training in the UK, The Gold Guide 2009,

Third Edition June 2009, Section 7).

For trainees with an NTN or NTN(A) in an approved UK training programme, the curriculum is integrated with and supported by the followingdocuments in order to produce a coordinated training package for the award of the CCT. The relevant package includes:

a blueprint for the histopathology assessment system(this demonstrates how the College assessments and examinations test the structure ofthe curriculum)

regulations and guidelines for workplace-based assessment

multi-source feedback

Year 1 Histopathology Assessment

regulations and guidelines for Fellowship exams

access to e-learning mapped to the histopathology curriculum

competency-based framework for graded responsibility

Learning Environment for Pathology Trainees (LEPT)which provides an electronic means of recording progress in training

Annual Review of Competence Progression (ARCP) guidance

Doctors applying for a CESR in histopathology must be able to demonstrate equivalence to the requirements for the award of a histopathology CCT.Such doctors are strongly advised to read PMETBs Guidance on applying for a CESR under Article 14. In addition, the following guidance isavailable from the College and should also be carefully followed in the preparation of a CESR application:

general guidance on evidence to submit with applications for a CESR (Article 14) in Histopathology (specialty-specific guidance)

guidance for CESR applicants in specialties and subspecialties overseen by The Royal College of Pathologists

CESR curriculum vitae guidance.
http://www.pmetb.org.uk/fileadmin/user/Standards_Requirements/PMETB_Scas_July2008_Final.pdfhttp://www.pmetb.org.uk/fileadmin/user/Standards_Requirements/PMETB_Scas_July2008_Final.pdfhttp://www.pmetb.org.uk/fileadmin/user/Standards_Requirements/PMETB_Scas_July2008_Final.pdfhttp://www.mmc.nhs.uk/specialty_training_2010/gold_guide.aspxhttp://www.mmc.nhs.uk/specialty_training_2010/gold_guide.aspxhttp://www.pmetb.org.uk/index.php?id=976http://www.pmetb.org.uk/index.php?id=976http://www.rcpath.org/index.asp?PageID=1462http://www.rcpath.org/index.asp?PageID=1462http://www.rcpath.org/index.asp?PageID=1603http://www.rcpath.org/index.asp?PageID=1603http://www.rcpath.org/index.asp?PageID=942http://www.rcpath.org/index.asp?PageID=47http://www.rcpath.org/index.asp?PageID=47http://www.rcpath.org/index.asp?PageID=116http://www.rcpath.org/index.asp?PageID=116http://www.rcpath.org/index.asp?PageID=1061http://www.rcpath.org/index.asp?PageID=1061http://www.rcpath.org/index.asp?PageID=1546http://www.rcpath.org/index.asp?PageID=1546http://www.pmetb.org.uk/cesrhttp://www.pmetb.org.uk/cesrhttp://www.pmetb.org.uk/cesrhttp://www.rcpath.org/index.asp?PageID=1546http://www.rcpath.org/index.asp?PageID=1061http://www.rcpath.org/index.asp?PageID=116http://www.rcpath.org/index.asp?PageID=47http://www.rcpath.org/index.asp?PageID=942http://www.rcpath.org/index.asp?PageID=1603http://www.rcpath.org/index.asp?PageID=1462http://www.pmetb.org.uk/index.php?id=976http://www.mmc.nhs.uk/specialty_training_2010/gold_guide.aspxhttp://www.pmetb.org.uk/fileadmin/user/Standards_Requirements/PMETB_Scas_July2008_Final.pdfhttp://www.pmetb.org.uk/fileadmin/user/Standards_Requirements/PMETB_Scas_July2008_Final.pdf


6/123


Entry requirements

Trainees are eligible for entry to a histopathology training programme following satisfactory completion of a UK foundation training programme or afterdemonstrating equivalent competencies. Entry is also possible following post-foundation clinical training. Information regarding entry to ST1 training inEngland and Wales is available from theNHS Histopathology Training Schools.Scottish and Northern Irish ST1 trainees do not enter specific trainingschools, but the programme is otherwise identical.

Duration of training

The Royal College of Pathologists anticipates that 5 years and 6 months would normally be required to satisfactorily complete the histopathologycurriculum to the required depth and breadth, including two of the three available optional packages of additional training described below, andachieve a CCT or CESR(CP). The minimum duration of training as identified in Schedule 3 of the General and Specialist Medical Practice (Education,Training and Qualification) Order 2003 is 4 years.

The CCT in histopathology will be awarded on the recommendation of The Royal College of Pathologists following:

evidence of satisfactory completion of the histopathology curriculum and the minimum training period

satisfactory outcomes in the requisite number of workplace-based assessments (including multi-source feedback)

attainment of the Colleges Year 1 Histopathology Assessment

FRCPath by examination in histopathology

acquisition of Annual Review of Competence Progression (ARCP) outcome 6.

Further detailed information about theannual progression points including assessment requirementsthat will enable progression at each ARCP, as

well as the completion of theCCTorCESR(CP)is available on the College website.

Subspecialty training in Cytopathology (see Appendix 2)

It is possible for trainees to undertake postgraduate subspecialty training in cytopathology after satisfactory completion of stages A, B and C oftraining and attainment of FRCPath Parts 1 and 2 in histopathology. Subspecialty training should be undertaken during stage D of training, subject toevidence of completion of the appropriate histopathology competences and attainment of the FRCPath in histopathology. Up to 6 months training inthe subspecialty may be permitted prior to taking up designated subspecialty training. Satisfactory completion of the cytopathology subspecialtytraining programme can lead to inclusion against an entry on the Specialist Register. Trainees can complete the CCT requirements and subspecialty

training in a minimum of 5 years and 3 months (including stages AC of histopathology training and the 3-month cervical cytopathology optionaltraining package). Trainees undertaking subspecialty training will spend stage D of training entirely within their chosen subspecialty, whilst continuingto accumulate the competencies described as necessary for completion of stage D of the histopathology curriculum.

Trainees may have the subspecialty of cytopathology included against a histopathology entry on the Specialist Register following:
http://nhshistopathology.net/http://nhshistopathology.net/http://nhshistopathology.net/http://www.rcpath.org/index.asp?PageID=116http://www.rcpath.org/index.asp?PageID=116http://www.rcpath.org/index.asp?PageID=116http://www.rcpath.org/index.asp?PageID=817http://www.rcpath.org/index.asp?PageID=817http://www.rcpath.org/index.asp?PageID=817http://www.rcpath.org/index.asp?PageID=1598http://www.rcpath.org/index.asp?PageID=1598http://www.rcpath.org/index.asp?PageID=1598http://www.rcpath.org/index.asp?PageID=1598http://www.rcpath.org/index.asp?PageID=817http://www.rcpath.org/index.asp?PageID=116http://nhshistopathology.net/


7/123


evidence of satisfactory completion of the cytopathology subspecialty curriculum and 1 years training overall in a recognised cytopathologytraining programme during stage D of training

completion of a satisfactory cytopathology subspecialty training logbook.

STAGES OF TRAINING AND LEARNING

The curriculum is divided into four stages, AD. Trainees may not progress to the next stage of training until they have satisfactorily completed thepreceding stage. Trainees should gain appropriate experience within their programme to achieve all necessary curricular objectives.

Experience in Neuropathology and Paediatric Pathology is recommended during either stage A or B of training; in whichever stage this experience isgained, the total recommended time spent in these areas is 2 weeks each. The aim of these attachments is to allow the trainee to gain experience ofworking and to consider the possibility of a career in either of these specialist areas.

It is strongly recommended that during Stages BC, trainees should take increasing levels of responsibility for their work as they progress towardsindependent practice. This can be facilitated by the assessment of general histopathology competencies as set out in the competency-basedframework for graded responsibility.Independent accountable practice is one of the required activities within stage D of training.

Throughout training, trainees should maintain a training portfolio; this is available online in the form of the RCPath Learning Environment forPathology Trainees (LEPT)here.Stage A

Stage A of training is 12 months whole-time equivalent.

The aims of this stage are to provide:

a structured introduction to histopathology (including cytopathology and autopsy pathology)

a short practical introduction to paediatric pathology (either stage A orB, recommended 2 weeks total)

a short practical introduction to neuropathology (either stage A orB, recommended 2 weeks total).

Competences required to exit stage A: independent cut-up of most simple specimens (e.g. appendicectomy, cholecystectomy, skin biopsies, etc.)

independent cut-up of common larger specimens (e.g. colectomy for cancer, simple nephrectomy, breast lumpectomy, etc.)

ability to write an appropriate report for a wide range of histopathology and cytopathology specimens (common biopsies, common cancerresections, e.g. colorectal carcinoma, fine needle aspiration specimens)

ability to demonstrate time management and task prioritisation (e.g. prioritisation of specimens for cut-up and reporting, timely turn-around ofreporting histopathology or cytopathology specimens, keeping LEPT entries up to date)
http://www.rcpath.org/index.asp?PageID=116http://www.rcpath.org/index.asp?PageID=116http://www.rcpath.org/index.asp?PageID=116https://lept.rcpath.org/https://lept.rcpath.org/https://lept.rcpath.org/https://lept.rcpath.org/http://www.rcpath.org/index.asp?PageID=116http://www.rcpath.org/index.asp?PageID=116


8/123


independent evisceration and dissection of a straightforward autopsy

ability to write an autopsy report including appropriate clinicopathological correlation for a straightforward case.

Minimum practical experience:

surgical histopathology 500 cases

cytopathology 150 cervical and 150 non-cervical cytopathology cases, which may either be new screening ordiagnostic cases, or be seen in the context of teaching sets with appropriate structured feedback froman experienced trainer

autopsy pathology 20 autopsies

audit completion of 1 audit.

Assessments:

workplace-based assessments 18 in total, 12 directed (see Appendix 6)

multi-source feedback 1 completed and satisfactory

year 1 assessment pass

educational supervisors report satisfactory

ARCP satisfactory outcome (1 or 2).

Stages BD: general advice regarding time spent in stagesThe time spent in training in stages B and C should amount to a total of 3 years and 6 months (42 months), assuming the trainee undertakes twooptional training packages. If no optional training packages are undertaken, stages B and C should amount to a total training time of 3 years (36months). This introduces a degree of flexibility into the time spent in these stages, relative to each other. If the trainee completes stage B in theminimum time of 12 months, 24 or 30 months should be spent in stage C, depending on optional packages. If the trainee takes 18 months tocomplete stage B, usually because they have required two attempts to pass the Part 1 FRCPath, 18 or 24 months should be spent in stage C.

If a trainee takes 18 months to complete stage B, and has not completed stage C within 18 or 24 months depending on optional packages, trainingshould be extended under the ARCP process and the CCT date delayed. If the trainee initially decides to undertake stages B and C without takingany optional packages, but then changes their mind before or during stage D and undertakes one or more optional packages after all, stage D shouldbe extended by an appropriate period of time (3 months per package undertaken).

Stage B

Stage B of training is a minimum of 12 months and a maximum of 18 months whole time equivalent, unless extended training is required.

The aims of this stage are to:

broaden experience and understanding of histopathology


9/123


broaden understanding of subspecialty pathology including all subspecialties

provide a short practical introduction to paediatric pathology (either stage A orB, recommended 2 weeks total)

provide a short practical introduction to neuropathology (either stage A orB, recommended 2 weeks total)

develop a basic knowledge base in cytopathology and autopsy pathology.

Competencies required to exit stage B:

independent cut-up of all simple specimens (see above for examples)

independent cut-up of all common larger specimens (including mastectomy, prostatectomy, complex hysterectomy specimens, etc)

ability to primary screen cervical samples

ability to write an appropriate report for a wide range of histopathology and cytopathology specimens (including more complex specimens thanthose described for stage A above)

ability to demonstrate effective time management and task prioritisation

independent evisceration and dissection of more complex autopsies (see those described as Complex post-mortems for observation in stage Acurriculum content, page 37)

ability to write an autopsy report including appropriate clinicopathological correlation for a more complex case (as described above).

Minimum practical experience (based on 12 months spent in stage; increased pro rata for extended stage):


cytopathology 200 cervical and 200 non-cervical cytopathology cases, which may either be new screening or diagnosticcases, or be seen in the context of teaching sets with appropriate structured feedback from anexperienced trainer

autopsy pathology 20 adult autopsies, 2 paediatric/ perinatal autopsies

audit completion of 1 audit in stage.

Assessments:

workplace-based assessments 18 in total, 12 directed (see Appendix 6)

FRCPath Part 1 pass (can be taken any time after 6 months in stage b)


ARCP satisfactory outcome (1 or 2).


10/123


Stage C

Stage C of training is a minimum of 24 months and a maximum of 30 months whole time equivalent, unless extended training is required. If nooptional training packages are undertaken, these timescales are each reduced by 6 months. In addition, the total training time in stages B and Cshould amount to 42 months, or 36 months if no optional training packages are undertaken (see above).

The aims of this stage are to:

develop increasing levels of confidence and the ability to work in appropriate contexts without direct supervision in histopathology, includingnon-cervical cytopathology.

Competencies required to exit stage C:

independent cut-up of all specimens

ability to report most histopathology and non-cervical cytopathology specimens

ability to appropriately refer for specialist/second opinion

ability to demonstrate appropriate time management and task prioritisation for the stage of training.

Minimum practical experience (per 12 month period in stage: increased pro rata for extended stage):


cytopathology 300 non-cervical cytopathology cases, the majority of which (approximately 70%) should be newdiagnostic cases

audit completion of 1 audit during stage.

Assessments

workplace-based assessments 18 in total, 12 directed (during stage)

multi-source feedback 1 completed (during year 3) and satisfactory

FRCPath Part 2 pass (earliest opportunity at 21 months in stage)


ARCP satisfactory outcomes (1 or 2).

Stage D

Stage D of training is a minimum of 12 months whole time equivalent.

In order to complete stage D of histopathology training, trainees must have:

satisfactorily completed a total of at least 66 months of training (whole-time equivalent), or 60 months if no optional training packages areundertaken

satisfactorily completed all areas of the histopathology curriculum.


11/123


The aims of this stage are achieved by following a specific training plan to be formulated by the local Training Committee and require trainees to:

demonstrate a level of knowledge and skill consistent with practise as a consultant in that specialty in the national health service

demonstrate the ability to report independently

explore specialist interest or more in-depth general reporting

develop experience of teaching histopathology trainees

develop experience of involvement in MDTs

demonstrate evidence of the above achievements in a training portfolio.

Competencies required to exit stage D (which must show development beyond stage C):

to demonstrate a level of knowledge and skill consistent with practise as a consultant in histopathology in the National Health Service

to demonstrate the ability to report independently

to explore specialist interest or more in-depth general reporting

to develop experience of teaching histopathology trainees

to develop experience of involvement in MDTs

to demonstrate evidence of the above achievements in a training portfolio.

Practical experience per 12-month period in stage (increased pro rata for extended stage):

surgical histopathology 1500 cases suggested (dependent on specialist interest) cytopathology 300 non-cervical cytopathology cases (suggested), the majority (80%) of which should be new diagnostic

cases

audit completion of 1 audit during stage.

Assessments:

workplace-based assessments 12 in total (all directed in training plan, see Appendix 6)

multi-source feedback 1 completed (during year 5) and satisfactory


ARCP satisfactory outcome (6).

Subspecialty training in cytopathology

Entry to Cytopathology subspecialty training requires completion of the general histopathology curriculum to the end of stage C, including the OptionalTraining Package in Cervical Cytopathology and all its requirements, with subspecialty training being undertaken either during stage D or post CCT.This is likely to necessitate rotation to different departments and secondment to other organisations. Subspecialty Cytopathology training requires aminimum of 12 months and a maximum of 18 months whole time equivalent, unless extended training is required.


12/123


Opportunities for research or management projects exist during this period.

The aims of subspecialty training are to:

acquire competencies of a specialist cytopathologist, able to act as local lead and providing specialist diagnostic services, within their Trust andbeyond.

demonstrate a level of knowledge and skill consistent with practice as a specialist consultant cytopathologist within the National Health Service

demonstrate the ability to report a full range of cervical cytopathology and diagnostic cytopathology samples independently

demonstrate a detailed working knowledge of all aspects of the NHS Cervical Screening Programme

demonstrate a working knowledge of the applicability of diagnostic cytopathology to patient management

demonstrate the ability to take fine needle cytology specimens

demonstrate the ability to advise clinical colleagues on the taking and submission of cytopathology specimens to the laboratory

demonstrate detailed knowledge of the use of ancillary techniques in cytopathology

develop the approach to multidisciplinary team working and the conduct of multidisciplinary team meetings

develop experience of teaching diagnostic cytopathology to histopathology trainees.

The competencies required for the completion of subspecialty training include:

the ability to report the vast majority of cervical cytopathology and non-cervical cytopathology specimens independently. Familiarity with allmethods and stains in common use is expected.

the ability to use this diagnostic information in a clinical setting.

the ability to refer appropriately for specialist/second opinion

the ability to liaise with other professional agencies responsible for delivering the Cervical Screening Programme with an understanding of therole and responsibilities of all key individuals (including QA team, hospital-based programme coordinator, screening commissioner and leadcytopathologist).

the ability to interpret quality assurance data/performance indicators/audit data from screening programmes and clinical practice

the ability to communicate benefits and limitations of screening with other health professionals and lay people.

the ability to report in a rapid diagnosis one stop clinic setting, and recognise specimens which cannot be reported safely in that setting

the ability to perform fine needle aspirates.

the ability to use ancillary techniques (including immunocytochemistry, flow cytometry, molecular techniques) appropriately to achieve adiagnosis.

the ability to function effectively in the multidisciplinary team setting

the ability to manage non-correlation between cytology and other investigations including colposcopy and histology.

the ability to teach in workplace and formal settings.


13/123


Practical experience:

time spent in subspecialty: at least 12 months whole time equivalent in stage D or post CCT

cytopathology specimens: at least 1000 reports on cervical cytopathology samples with an appropriate mix of normal and abnormal,and the great majority of which should be new screening samples, rather than teaching sets;at least 1000 diagnostic cytopathology samples with an appropriate mix of specimen sites and types.

clinics at least 30 rapid diagnosis clinics, at least 15 of which include the taking of specimens from the patient;experience of reporting deep endoscopic ultrasound guided FNA specimens.

Assessments:

workplace-based assessments 18 satisfactory in total, 12 directed (see Appendix 6).


ARCP outcome 6 (including assessment of Cytopathology training logbook)

OPTIONAL TRAINING

In addition to the histopathology curriculum there are optional training packages available to Stage C or D histopathology trainees in higher autopsytraining, cervical cytology and research methodology. Whilst not a constituent part of the histopathology CCT, these form part of the overallhistopathology training programme for those trainees wishing to undertake training in these areas. Each package equates to an indicative period of 3months training; it is anticipated that within a 5 year training programme a trainee could undertake two of these three modules assuming successfulcompletion of all other assessments in a timely fashion as described above. If a trainee decides not to undertake any of these modules and stillachieves successful completion of the other assessments, the training programme may be shortened to 5 years.

The optional packages are:

1. Cervical cytopathology

The aims of this package are to:

demonstrate a level of knowledge and skill consistent with practise as a consultant reporting cervical cytopathology specimens in the NationalHealth Service

demonstrate the ability to report cervical smears independently

demonstrate a working knowledge of the cervical screening programme and the management of patients within that programme

develop experience of teaching cervical cytopathology to histopathology trainees

develop experience of involvement in cervical cancer MDTs.

Competencies required to complete package:

ability to report most cervical cytopathology specimens (including all grades of squamous and glandular abnormalities)

ability to appropriately refer for specialist/second opinion


14/123


ability to demonstrate excellent time management and task prioritisation in relation to cervical screening specimens (including prioritisation ofdifferent cervical specimens for reporting, ongoing maintenance of training portfolio, etc.)

ability to function effectively in a cervical cancer MDT setting

ability to teach in workplace and formal settings

ability to interpret performance indicators routinely used in the NHS cervical screening programme

ability to liaise with other professional agencies responsible for delivering Cervical Screening Programme.


time spent in specialty at least 3 months whole time equivalent in stage C, or exceptionally stage D of training

cytopathology specimens at least 500 cervical cytopathology specimens with an appropriate mix of normal and abnormal, the greatmajority of which should be new screening samples, rather than teaching sets

Assessments:

workplace-based assessments 4 in total, all directed (see Appendix 6)

CHCCT pass (Certificate of Higher Cervical Cytopathology Training)


2. Higher autopsy training


demonstrate a level of knowledge and skill consistent with practise as a consultant undertaking autopsies for the National Health Service or HerMajestys Coroners/Procurator Fiscal

demonstrate the ability to carry out and report autopsies independently, including the interpretation of relevant histopathology and otherspecialist investigations

demonstrate a working knowledge of the Coroners Rules and experience of the proceedings in the Coroners Court/Death and the ProcuratorFiscal 2008 and proceedings of a Fatal Accident Inquiry

demonstrate a working knowledge of the Human Tissue Act and the health and safety regulations relevant to autopsy practice

develop experience of teaching autopsy technique to histopathology trainees.


ability to technically carry out most autopsies including the majority of complex and infectious cases (see page 37, Complex post-mortemexaminations)

ability to report appropriate autopsy histopathology and to interpret other relevant specialist investigations

ability to appropriately refer cases and investigations to a more experienced colleague for specialist/second opinion

ability to demonstrate excellent time management and task prioritisation in relation to autopsy practice (including ability to recognise whichautopsies need to be undertaken as a matter of priority, e.g. for issues relating to faith)


15/123


ability to function effectively/competently in a Coroners Court/Fatal Accident Inquiry

ability to teach in workplace and formal settings.


time spent in specialty at least 3 months full time equivalent in stage C, or exceptionally stage D of training

autopsy numbers at least 60 autopsies in the package (overall a minimum of 100 autopsies completed during full trainingprogramme) with a full and proportionate range of different case types

attendance at court experience of attendance at Coroners Court/Fatal Accident Inquiry.

Assessments:


CHAT pass (Certificate of Higher Autopsy Training)

educational supervisors report satisfactory.

3. Research methodology


prepare a trainee to undertake research within their job plan after completion of training enable a consultant to recognise good research of a type that might influence their clinical work

educate trainees about the requirements of audit.


ability to apply the fundamentals of the scientific process and evidence-based medicine

ability to apply the ethical principles of research on humans, animals and tissue

ability to design a research study that is recognised by peers and colleagues as relevant and well constructed

ability to review and critically analyse research and summarise its limitations and applications in clinical practice.


a 3-month attachment, preferably in a single block of time, which is likely to be within an academic department, although some non-academicdepartments may also be able to offer this module with appropriate facilities and expertise. Training may be offered during stage B, C or(exceptionally) D of training

design a research study, including addressing ethical and funding issues, that is recognised by the research supervisor as relevant and wellconstructed

write a scientific paper or book chapter that is peer reviewed and assessed by the research supervisor as being suitable for submission forpublication, including a critical review of the research literature relevant to the subject of the paper or chapter.


16/123


Appendices 3ac contain detailed curricula and assessment processes for these optional packages.

Assessments:


training portfolio research methodology logbook to be completed to a satisfactory standard

research supervisors report satisfactory.

Training programmes

Training programmes will be quality assured by PMETB. Training posts and programmes will be recommended for approval by the relevantPostgraduate Deanery with input from The Royal College of Pathologists.

Training programmes should include suitable rotational arrangements to cover all the necessary areas of the curriculum and an appropriate balancebetween teaching hospitals, district general hospitals and specialist units, such that each trainee gains the breadth of training required for satisfactorycompletion of the curriculum. The exact rotational arrangements will vary according to the size of the departments in the various training hospitals, thenumber of placements on the training scheme and the number of other trainees on the training programme. The training programme should beorganised in such a way as to give each trainee some experience in most recognised areas of subspecialisation.

The structure and operation of the training programme is the responsibility of a Specialty Training Committee (STC), which will ensure that everytrainee is provided with an appropriate range of educational experience to complete their training.

The local Programme Director and Regional Specialty Advisor are responsible for the overall progress of the trainee and will ensure that the traineesatisfactorily covers the entire curriculum by the end of the programme.

Each trainee should have an identified educational supervisor at every stage of their training. The educational supervisor is the consultant underwhose direct supervision the trainee is working. A trainer is any person involved in training the trainee [e.g. consultant, clinical scientist, seniorbiomedical scientist (BMS)]. A trainee may be trained by a number of trainers during their training.

If there is a breakdown of relationship between a trainee and their educational supervisor, the trainee should, in the first instance seek advice fromtheir training programme director. If the matter is not resolved to the trainees satisfaction, then he/she should seek further advice from the head of

pathology school. As a last resort, trainees can seek advice from the College through the appropriate College specialty advisors.


17/123


Training regulations

This section of the curriculum outlines the training regulations for Histopathology. In line with PMETB, this reflects the regulation that only training that

has been prospectively approved by PMETB can lead towards the award of the CCT. Training that has not been prospectively approved by PMETB

can still be considered but the trainees route of entry to the Specialist Register changes to CESR through the CP route.

Less than full-time training

Less than full-time training (previously referred to as f lexible training) is the term used to describe doctors undertaking training on a basis that is lessthan full-time, normally between five and eight sessions per week. The aim of less than full-time training is to provide opportunities for doctors in theNHS who are unable to work full time. Doctors can apply for less than full-time training if they can provide evidence that training on a full-time basiswould not be practicable for well-founded individual reasons.

Less than full-time trainees must accept two important principles:

part-time training shall meet the same requirements (in depth and breadth) as full-time training

the total duration and quality of part-time training of specialists must be not less than those of a full-time trainee.In other words, a part-time trainee will have to complete the minimum training time for their specialty pro rata.

PMETB guidance on approval of flexible training states that from 1 December 2007, Deaneries, in conjunction with Royal Colleges/Faculties, willtake responsibility for ensuring that all less than full-time training of any kind is undertaken in prospectively approved posts and programmes and thatit meets the statutory requirements of the General and Specialist Medical Practice (Education, Training and Qualifications) Order 2003. Prior tobeginning their less than full-time training, trainees must inform the Training and Educational Standards Department at The Royal College ofPathologists in order that the Histopathology College Advisory Training Team (CATT) can ensure that their less than full-time training programme willcomply with the requirements of the CCT. The documentation towards a less than full-time training application will be collected and checked to ensurecompliance and a revised provisional CCT date issued. Separate guidance and an application form are available on the College website for thispurpose.

Research

Some trainees may wish to spend a period of time in research after entering histopathology training as out-of-programme research (OOPR).

Research undertaken prior to entry to a histopathology training programmeTrainees who have undertaken a period of research that includes clinical work directly relevant to the histopathology curriculum prior to entering ahistopathology training programme can have this period recognised towards an entry on the Specialist Register. However, as the research is unlikelyto have been prospectively approved by PMETB, their route of entry to the Specialist Register will be through the CESR.
http://www.pmetb.org.uk/fileadmin/user/QA/Post_and_programme_approval/Flexible_training.pdfhttp://www.rcpath.org/index.asp?PageID=677http://www.rcpath.org/index.asp?PageID=677http://www.pmetb.org.uk/fileadmin/user/QA/Post_and_programme_approval/Flexible_training.pdf


18/123


Research undertaken during entry to a histopathology training programmeTrainees who undertake a period of out-of-programme research (OOPR) after entering a histopathology training programme and obtaining theirNational Training Number (NTN) can have up to 1 year accepted by the Histopathology CATT towards their CCT. In order to be eligible to have thisperiod of research recognised towards the award of the CCT, trainees must have their OOPR approved prospectively by PMETB before beginningtheir research. Prior to beginning the period of research, trainees must agree the OOPR with their Deanery and inform the Training andEducational Standards Department at The Royal College of Pathologists in order that the Histopathology CATT can ensure that the traineewill comply with the requirements of the CCT programme. The period of research must include clinical work directly relevant to the

Histopathology curriculum. The documentation towards a CCT recommendation will be collected by the Training and Educational StandardsDepartment at the College, checked to ensure compliance and a revised provisional CCT date issued. It must be ensured that, following deaneryagreement and acceptance from the Histopathology CATT, PMETB prospectively approve the OOPR in order that the period can count towards aCCT. Separate guidance and an application form are available on theCollege website for this purpose.

Academic trainees

Trainees who intend to pursue a career in academic or research medicine may undertake specialist training in histopathology. Such trainees willnormally be clinical lecturers and hold an NTN(A). It is expected that such trainees should complete the requirements of the histopathology curriculumin addition to their academic work. However, the content of their training, while meeting the requirements of the curriculum, will have to take intoaccount their need to develop their research and the provisional CCT date should be amended accordingly. NTN(A) holders in histopathology shouldconsult the Training and Educational Standards Department at the College on an individual basis with regard to the agreement of their provisional

CCT date.

Overseas training

Overseas training undertaken prior to entry to a histopathology training programmeSome trainees may have undertaken a period of histopathology training overseas prior to entering a histopathology training programme in the UK.Such trainees must enter a histopathology training programme at ST1. Trainees can have this period recognised towards an entry on the SpecialistRegister but their route of entry to the Specialist Register will be through the CESR.

Overseas training undertaken during entry to a histopathology training programmeSome trainees may wish to spend a period of training overseas as out-of-programme training (OOPT) after entering a histopathology trainingprogramme in the UK. In order to be eligible to have this period of training recognised towards the award of the CCT, trainees must have

their OOPT overseas training approved prospectively by PMETB before beginning their overseas training. Prior to beginning the period ofoverseas training, trainees must agree the OOPT with their Deanery and inform the Training and Educational Standards Department at The RoyalCollege of Pathologists that they will be undertaking overseas training in order that the Histopathology CATT can ensure that the trainee will complywith the requirements of the CCT programme. The documentation towards a CCT recommendation will be collected by the Training and EducationalStandards Department at the College, checked to ensure compliance and a revised provisional CCT date issued. It must be ensured that, followingDeanery agreement and acceptance from the Histopathology CATT, PMETB prospectively approves the OOPT in order that the period can counttowards a CCT. Separate guidance and an application form are available on theCollege website for this purpose.
http://www.rcpath.org/index.asp?PageID=755http://www.rcpath.org/index.asp?PageID=755http://www.rcpath.org/index.asp?PageID=754http://www.rcpath.org/index.asp?PageID=754http://www.rcpath.org/index.asp?PageID=754http://www.rcpath.org/index.asp?PageID=755


19/123


Related clinical training

During their histopathology training, some trainees may wish to spend a period of training in a related clinical specialty such as paediatrics, neurologyor oncology, etc. This is acceptable and should be undertaken as out-of-programme clinical experience (OOPE). However, such a period of training although useful to the individual trainee in broadening their understanding of the relationship between histopathology and the clinical specialties willnot be approved by the CATT towards the requirements of the CCT and the clinical specialties.

RATIONALE

Purpose of the curriculum

The purpose of the curriculum for specialty training in histopathology and its related subspecialty is to set the standards required by The RoyalCollege of Pathologists and PMETB for attainment of the award of the CCT or CESR(CP) in histopathology and its subspecialties (whereappropriate), and to ensure that trainees are fully prepared to provide a high quality service at consultant level in the NHS. In addition, the curriculumalso sets the standards against which CESR applicants will be judged.

The educational programme provides:

experience of the diagnostic techniques required to become technically competent in practical work, and to master the underlying analytical andclinical principles

the opportunity to gain knowledge of specialist areas such as cytopathology, forensic pathology, neuropathology and paediatric pathology, inorder to be able to make appropriate referrals for specialist advice

training in the communication and teaching skills necessary for effective practice

the opportunities to develop to the required standard the ability to provide specialist opinion in histopathology

opportunities to acquire the management skills to lead a department providing an effective service

experience of research and development projects and critical assessment of published work so as to contribute in a team and individually to thedevelopment of the service

the framework for continued professional development (CPD) including life-long habits of reading, literature searches, consultation withcolleagues, attendance at scientific meetings and the presentation of scientific work

practical experience of clinical governance and audit (specialist and multidisciplinary) through evaluation of practice against the standards ofevidence-based medicine.

Clinical governance is defined by the Department of Health as a framework through which NHS organisations are accountable for continuouslyimproving the quality of their services and safeguarding high standards of care, by creating an environment in which excellence in clinical care willflourish. In histopathology, trainees must become familiar with the lines of accountability, quality improvement programmes, clinical audit, evidence-based practice, clinical standards and guidelines, managing risk and quality assurance programmes. Training in these areas will continue throughoutall stages of the curriculum.


20/123


The award of a CCT or CESR(CP) will indicate suitability for independent professional practice. During training, trainees will be able to use thecurriculum and feedback from assessments to monitor their progress towards this goal. All assessments and examinations will be based on curricularobjectives and competencies

Curriculum development

This curriculum was originally developed in 2005 (with subsequent review and amendments made in 2007 and 2008) by the Histopathology CATT

and the Curriculum Review Group, with input from the Specialty Advisory Committees (SAC) on Histopathology and Paediatric Pathology; theCytopathology Subcommittee and Examination Panels of The Royal College of Pathologists, who have also had the same input into this version. Inaddition, the Colleges Lay Advisory Committee (LAC) and Trainee Advisory Committee (TAC) were consulted and a draft version of the curriculumwas published on the College website for consultation with College Fellows and Registered Trainees on 16 November 2009 for a 2-week period.

The content of this curriculum was derived from current UK hospital practice in histopathology. Educational supervisors and trainees were involved inits development via their representation on various College committees such as the Histopathology CATT, SAC on Histopathology, the relatedsubspecialtys sub-committees and the Trainees Advisory Committee (TAC).

This version of the curriculum is designed to be trainee-focussed, to allow trainees to take control of their own learning and to measure achievementagainst objectives. It will help in the formulation of a regularly updated education plan in conjunction with an educational supervisor and the localspecialty training committee.

The curriculum was agreed by the Histopathology Pathology CATT on 14 September 2009 and the Joint Committee on Pathology Training (JCPT) on

16 October 2009 and approved by the Council of The Royal College of Pathologists on 14 January 2010.

The curriculum was approved by PMETB on 25 March 2010 and formally published in June 2010.

CONTENT OF LEARNING

The curriculum details the level of knowledge and its application, skill and professional behaviour that a trainee should acquire and demonstrate inpractice to provide a high quality service at consultant level in the NHS. The professional practice aspect of the curriculum aims to ensure that doctorsin the NHS trained to the Royal College of Pathologists curriculum in Histopathology are competent practitioners, partners and leaders. It also aims toensure an understanding of issues of inequality around health and healthcare. Doctors must take the opportunity to positively influence healthdeterminants and to combat inequalities.

The general professional and specialty-specific content of the curriculum is outlined below.

1. Basic knowledge and skills (see pages 4288)

2. Clinical histopathology including surgical pathology, autopsy and cytopathology (see pages 4288)


21/123


3. Subspecialist areas of histopathology. The trainees will acquire a basic knowledge of cytopathology. Subspecialisation within this area may beundertaken (see Appendix 2)

4. Generic skills required for histopathology, in accordance with Good Medical Practice (see Appendix 7).

The curriculum outlines the knowledge, skills, behaviours and expertise that a trainee is expected to obtain in order to achieve the award of the CCT.

Additional guidance is provided for ST1 training (see Appendix 1) and subspecialty training (see Appendix 2), outlining the sequencing and learning

for this period of training. For training in ST25, it is expected that every trainee should undertake the core training outlined in pages 42 88, but it isrecognised that the sequencing of learning and experience will differ according to the programme. The curriculum maps components of Good MedicalPractice against the clinical components of histopathology and its associated subspecialties.

The recommended learning experiences are listed on page 23.

The Royal College of Pathologists is committed to supporting self-care, promoting well-being and community engagement, prevention and earlyintervention with services designed around the patient/service user rather than the needs of the patient/service user being obliged to fit with theservices offered. Therefore, the following common core principles of self-care are supported:

These are:Principle 1: Empower service users to make informed choices to manage their condition and care needs effectivelyPrinciple 2: Communicate effectively to enable service users to develop confidence in their self-care skillsPrinciple 3: Enable and support service users to use technology to support self-carePrinciple 4: Enable and support service users to develop skills in self-carePrinciple 5: Enable and support service users to participate in service planning and to access support networks.Further details are available inSupporting People with Long Term Conditions to Self Care: A guide to developing local strategies and best practice(2005).

Upon satisfactory completion of the histopathology training programme, the trainee must have acquired and be able to demonstrate:

appropriate professional behaviour to be able to work as a consultant

good working relationships with colleagues and the appropriate communication skills required for the practice of histopathology

the knowledge, skills and attitudes to act in a professional manner at all times

the knowledge, skills and behaviours to provide appropriate teaching and to participate in effective research to underpin histopathology practice an understanding of the context, meaning and implementation of clinical governance

a knowledge of the structure and organisation of the NHS

management skills required for the running of a histopathology laboratory

familiarity with health and safety regulations, as applied to the work of a histopathology department.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4100252http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4100252http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4100252


22/123


Purpose of assessment

The Royal College of Pathologists' mission is to promote excellence in the practice of pathology and to be responsible for maintaining standardsthrough training, assessments, examinations and professional development.The purpose of The Royal College of Pathologists' assessment system in histopathology and its subspecialties is to:

indicate suitability of choice at an early stage of the chosen career path

indicate the capability and potential of a trainee through tests of applied knowledge and skill relevant to the specialty

demonstrate readiness to progress to the next stage(s) of training having met the required standard of the previous stage provide feedback to the trainee about progress and learning needs

support trainees to progress at their own pace by measuring a trainee's capacity to achieve competencies for their chosen career path

help to identify trainees who should change direction or leave the specialty

promote and encourage learning

enable the trainee to collect all necessary evidence for the ARCP

gain Fellowship of The Royal College of Pathologists

provide evidence for the award of the CCT

assure the public that the trainee is ready for and capable of unsupervised professional practice.

A blueprint of the medical histopathology assessment system is available on thePMETB website.

Methods of assessment

Trainees will be assessed in a number of different ways during their training. Satisfactory completion of all assessments and examinations will bemonitored as part of the ARCP process and will be one of the criteria upon which eligibility to progress will be judged. Passes in the Year 1Histopathology Assessment and the FRCPath examination are required as part of the eligibility criteria for the award of the CCT.

Year 1 Histopathology Assessment

Trainees must pass theYear 1 Histopathology Assessmentas one of the requirements for satisfactory completion of Stage A of training.

Workplace-based assessment

Trainees will be expected to undertake workplace-based assessment throughout their training in histopathology. In general, workplace-basedassessments are designed to be formative in nature; as such they are best suited to determine educational progress in different contexts. To this end,it is strongly recommended that workplace-based assessment be carried out regularly throughout training to assess and document a traineesprogress. However, aminimum numberof satisfactory workplace-based assessments should be completed during each stage of training.

These will include:

case-based discussion (CbD)
http://www.pmetb.org.uk/index.php?id=976http://www.pmetb.org.uk/index.php?id=976http://www.pmetb.org.uk/index.php?id=976http://www.rcpath.org/index.asp?PageID=942http://www.rcpath.org/index.asp?PageID=942http://www.rcpath.org/index.asp?PageID=942http://www.rcpath.org/index.asp?PageID=1061http://www.rcpath.org/index.asp?PageID=1061http://www.rcpath.org/index.asp?PageID=1462http://www.rcpath.org/index.asp?PageID=1462http://www.rcpath.org/index.asp?PageID=1462http://www.rcpath.org/index.asp?PageID=1462http://www.rcpath.org/index.asp?PageID=1061http://www.rcpath.org/index.asp?PageID=942http://www.pmetb.org.uk/index.php?id=976


23/123


directly observed practical skills (DOPS)

evaluation of clinical events (ECE) multi-source feedback (MSF)(minimum of 3 during training).

Specific guidance for each stage and the optional packages of training is provided in Appendix 6.

Further separate guidance is provided about themethod and required frequencies of these assessments.

FRCPath examination

The major summative assessments will occur during Stage B (FRCPath Part 1 examination) and towards the end of Stage C (FRCPath Part 2examination).

The results of workplace-based assessments and examinations are evaluated by the JCPT as part of their role in monitoring training. Examinationresults are evaluated after each session and an annual review of validity and reliability is undertaken and reported to the Examinations Committee.

EVIDENCE OF COMPETENCE

Annual Review of Competence Progression (ARCP)

The ARCP is an annual opportunity for evidence gathered by a trainee, relating to the trainees progress in the training programme, to document thecompetences that are being gained. Evidence of competence will be judged based on a portfolio of documentation, culminating in an EducationalSupervisors Structured Report.

Separate ARCP guidance is available on the College website.A copy of all ARCP forms issued to the trainee must be provided to The Royal Collegeof Pathologists prior to recommendation for the award of the CCT. Lack of progress, identified by the issue of an ARCP outcome 3 or 5 andnecessitating additional training to rectify deficiencies will lead to the extension of training. Training leading to the issue of an ARCP 3 or 5 andnecessitating additional training will not be recognised towards the award of the CCT. Evidence of ARCP outcome 6 is required as part of theevidence for the award of the CCT.

MODELS OF LEARNING

There are three broad categories of learning which trainees employ throughout run-through training instructionalist model, constructionist model andthe social learning model. The models of learning can be applied to any stage of training in varying degrees. The majority of the curriculum will bedelivered through work-based experiential learning, but the environment within the departments will encourage independent self-directed learning. Itis the trainees responsibility to seek opportunity for experiential learning. The rotations are also arranged in such a way that trainees have time
http://www.rcpath.org/index.asp?PageID=1603http://www.rcpath.org/index.asp?PageID=1603http://www.rcpath.org/index.asp?PageID=1462http://www.rcpath.org/index.asp?PageID=1462http://www.rcpath.org/index.asp?PageID=1462http://www.rcpath.org/index.asp?PageID=1546http://www.rcpath.org/index.asp?PageID=1546http://www.rcpath.org/index.asp?PageID=1546http://www.rcpath.org/index.asp?PageID=1462http://www.rcpath.org/index.asp?PageID=1603


24/123


available for participation in research projects as part of their training. The more academically inclined trainees will be encouraged to take time outfrom the training time to include a more sustained period of grant-funded research working towards an MSc or PhD.

Most of the curriculum will be delivered through work-based experiential learning, but the environment within the department should encourageindependent self-directed learning and make opportunities for relevant off-the-job education by making provision for attendance at local, national and,where appropriate, international meetings and courses. Independent self-directed learning should be encouraged by, for example, making use of thee-learning tool or providing reference textbooks, etc. It is the trainees responsibility to seek opportunity for experiential learning. The rotas should also

be arranged in such a way that trainees have time available for participation in research projects as part of their training. More academically inclinedtrainees will be encouraged to take time out from the training time to include a more sustained period of grant-funded research, working towards anMD or PhD.

Learning for knowledge, competence, performance and independent action will be achieved by assessment and graded responsibility for reporting,allowing trainees at various stages of training to acquire responsibility for independent reporting. Assessment will be set by The Royal College ofPathologists in the form of workplace-based assessment including multi-source feedback, the Year 1 Histopathology Assessment and the FRCPathexamination.

LEARNING EXPERIENCES

The following teaching/learning methods will be used to identify how individual objectives will be achieved.

a. Routine work: the most important learning experience will be day-to-day work. Histopathology trainees are amongst the most closelysupervised groups in postgraduate medical training. This close supervision allows frequent short episodes of teaching, which may hardly berecognised as such by trainees.

b. Textbooks: histopathology departments have a wide range of reference texts available. These allow trainees to read around routine casesthat they are reporting. Histopathology is a subject requiring a great deal of background learning and reading, as well as the practicalexperience gained within day-to-day working, and trainees should take every advantage to read around their subject.

c. Private study: more systematic reading of textbooks and journals will be required in preparation for examinations.d. Black box and other departmental teaching sessions: these occur on a regular basis in most departments.e. Regional training courses: these are valuable learning opportunities. Trainees should be released from service duties to attend.f. National training courses: these are particularly helpful during preparation for the FRCPath Part 2 examination. In addition to providing

specific teaching, they also allow trainees to identify their position in relation to the curriculum and their peers.g. Scientific meetings: research and the understanding of research are essential to the practice of histopathology. Trainees should be

encouraged to attend and present their work at relevant meetings.h. Discussion with BMS: BMS staff can provide excellent training, particularly in relation to laboratory methods, health and safety, service

delivery, procurement and human resources.


25/123


i. Multidisciplinary team meetings (MDTs): attendance at and contribution to MDTs and clinicopathological conferences offers the opportunityfor trainees to develop an understanding of clinical management and appreciate the impact of histopathological diagnosis on patient care. TheMDT is also an important arena for the development of inter-professional communication skills.

j. Attachment to specialist departments: attachments of this kind will be required if a training programme cannot offer the full range of specialistexperience needed to complete the curriculum. They will also be beneficial for those trainees in their final year of training who wish to develop aspecial interest before taking up a consultant post.

k. E-learning.

l. Learning with peers.m. Work-based experiential learning.n. Medical clinics including specialty clinics.o. Multidisciplinary team meetings.p. Practical laboratory experience.q. Formal postgraduate teaching.r. Independent self-directed learning.s. Formal study.

SUPERVISION AND FEEDBACK

Specialist training must be appropriately supervised by the senior medical and scientific staff on a day-to-day basis under the direction of adesignated educational supervisor and an STC that links to the appropriate Postgraduate Deanery.

Supervision has more than one meaning in histopathology. Trainees will work under consultant supervision in the histopathology, cytopathology andautopsy services, gradually widening their knowledge and experience in each area so that by the time they have passed the FRCPath Part 2examination they are able to work largely independently. The day-to-day supervised training will be supplemented by more formal teaching such asblack box sessions and on regionally and nationally organised training courses (see above).

If a histopathology report generated by the trainee states that they have been supervised by a consultant, this is usually taken to mean that theconsultant has examined that report with the trainee. It also implies that the consultant accepts not only the microscopic but also any macroscopicdescription as accurate, even if the supervisor has not personally reviewed the specimen. However, there is also a more general level of supervisionin day-to-day work. A trainee may ask for assistance at any time if a specimen with which they are dealing is unfamiliar or unusual. In the mortuary, a

trainee competent in basic autopsy practice will be able to seek advice if an unusual or unexpected finding is encountered. Supervision also extendsto working relationships and communication within and beyond the histopathology department.

Educational supervision is a fundamental conduit for delivering teaching and training in the NHS. It takes advantage of the experience, knowledgeand skills of educational supervisors/trainers and their familiarity with clinical situations. It ensures interaction between an experienced clinician and adoctor in training. This is the desired link between the past and the future of medical practice, to guide and steer the learning process of the trainee.


26/123


Clinical supervision is also vital to ensure patient safety and the high quality service of doctors in training.

The College expects all doctors reaching the end of their training to demonstrate competence in clinical supervision before the award of the CCT. TheCollege also acknowledges that the process of gaining competence in supervision starts at an early stage in training with foundation doctorssupervising medical students and specialty registrars supervising more junior trainees.

The role of the educational supervisor is to:

have overall educational and supervisory responsibility for the trainee in a given post ensure that the trainee is familiar with the curriculum relevant to the year/stage of training of the post

ensure that the trainee has appropriate day-to-day supervision appropriate to their stage of training

ensure that the trainee is making the necessary clinical and educational progress during the post

ensure that the trainee is aware of the assessment system and undertakes it according to requirements

act as a mentor to the trainee and help with both professional and personal development

agree a training plan (formal educational contract) with the trainee and ensure that an induction (where appropriate) has been carried out soonafter the trainees appointment

discuss the trainees progress with each trainer with whom a trainee spends a period of training

undertake regular formative/supportive appraisals with the trainee (two per year, approximately every 6 months) and ensure that both partiesagree to the outcome of these sessions and keep a written record

regularly inspect the trainees training record, inform trainees of their progress and encourage trainees to discuss any deficiencies in the trainingprogramme, ensuring that records of such discussions are kept

keeps the STC Chair informed of any significant problems that may affect the individuals training.

In order to become an educational supervisor, a consultant must have a demonstrated interest in teaching and training, appropriate access toteaching resources, be involved in and liaise with the appropriate regional training committees and be involved in annual reviews and liaise closelywith the Specialty Training Committee. Educational supervisors are expected to keep up-to-date with developments in postgraduate medical training(e.g. by attending Deanery and national training the trainer courses), have access to the support and advice of their senior colleagues regarding anyissues related to teaching and training and to keep up-to-date with their own professional development.

MANAGING CURRICULUM IMPLEMENTATION

The curriculum outlines the minimum histopathology training requirements for delivery in a regional training programme. It guides educationalsupervisors as to what is required to deliver the curriculum and guides trainees in the learning and assessment methods required for satisfactorycompletion of training.

It is the responsibility of the Training Programme Director and their Deanery/Postgraduate School, with the assistance of the regional STC andsupported by the Regional Specialty Advisor, to ensure that the programme delivers the depth and breadth of histopathology and subspecialty


27/123


training outlined in the curriculum. The Programme Director must ensure that each post or attachment within the programme is approved by PMETB.Heads of Pathology School (HOPS) have a strategic overview of training in the Pathology specialties. They are responsible for ensuring that thedelivery of education and training meets the College- and PMETB-agreed curriculum and is provided to the standards set by the College and PMETB.

It is the responsibility of PMETB and Deaneries to quality assure training programmes to ensure training programmes across the UK are able todeliver a balanced programme of training.

It is the responsibility of the educational/clinical supervisor of a particular post or attachment within a programme to ensure that the training deliveredin their post meets the requirements of the relevant section(s) of the curriculum. The educational supervisor must undertake regular educationalappraisal with their trainee, at the beginning, middle and end of a section of training, to ensure structured and goal-oriented delivery of training.

Trainees mustregister with The Royal College of Pathologists on appointment to a histopathology training programme. It is the trainees responsibilityto familiarise themselves with the curriculum and assessment requirements both for the satisfactory completion of each stage of training and theaward of the CCT or CESR(CP). They must be familiar with all aspects of the assessment system; workplace-based assessment including multi-source feedback, the Year 1 Histopathology Assessment and the FRCPath examination. It is the trainees responsibility to ensure that they apply ingood time for any assessments and examinations that demand an application. Trainees must also make appropriate use of theLEPTsystem and e-learning.

CURRICULUM REVIEW AND UPDATING

The curriculum will be evaluated and monitored by The Royal College of Pathologists as part of continuous feedback from STCs, ProgrammeDirectors, Regional Specialty Advisors, trainers and trainees.

The curriculum will be formally reviewed in the first instance by the Histopathology CATT Curriculum Review Group within 2 years of publication. Inreviewing the curriculum, opinions will be sought from the Colleges SAC on Histopathology, its related subspecialty sub-committees, the Trainees

Advisory Committee, the Lay Advisory Committee and its Fellows and Registered Trainees.

Any significant changes to the curriculum will need the approval of The Royal College of Pathologists Council and PMETB.

EQUALITY AND DIVERSITY

Extract from The Royal College of Pathologists Diversity and equality policy and approach (December 2006). A full copy of the policy is available ontheCollege website.

The Royal College of Pathologists is committed to the principle of diversity and equality in employment, membership, academic activities,examinations and training. As part of this commitment we are concerned to inspire and support all those who work with us directly and indirectly.
http://www.rcpath.org/index.asp?PageID=486http://www.rcpath.org/index.asp?PageID=486https://lept.rcpath.org/https://lept.rcpath.org/https://lept.rcpath.org/http://www.rcpath.org/index.asp?PageID=912http://www.rcpath.org/index.asp?PageID=912http://www.rcpath.org/index.asp?PageID=912http://www.rcpath.org/index.asp?PageID=912https://lept.rcpath.org/http://www.rcpath.org/index.asp?PageID=486


28/123


Integral to our approach is the emphasis we place on our belief that everyone should be treated in a fair, open and honest manner. Our approach is acomprehensive one and reflects all areas of diversity, recognising the value of each individual. We aim to ensure that no one is treated lessfavourably than another on the grounds of ethnic origin, nationality, age, disability, gender, sexual orientation, race or religion. Our intention is toreflect not only the letter but also the spirit of equality legislation.

Our policy will take account of current equality legislation and good practice. Key legislation includes:

The Race Relations Act 1976 and the Race Relations Amendment Act (RRAA) 2000 The Disability Discrimination Act 1995 and subsequent amendments

The Sex Discrimination Act 1975 and 1986 and the 1983 and 1986 Regulations

The Equal Pay Act 1970 and the Equal Pay (Amendment) Regulations 1983 and 1986

The Human Rights Act 1998

The Employment and Equality (Sexual Orientation) Regulations 2003

The Employment and Equality (Religion or Belief) Regulations 2003

Gender Recognition Act 2004

The Employment Equality (Age) Regulations 2006.

The Training and Educational Standards Department collects information about the gender and ethnicity of trainees as part of their registration with

the College. This information is recorded by the College and statistics published on an annual basis in the annual report. Further information aboutthe monitoring activities of the College trainees, candidates and Fellows are available in the College policy.

ACKNOWLEDGEMENTS

Dr David Bailey [current Histopathology College Advisory Training Team (CATT) Chair], Dr Adrian Bateman (immediate past Histopathology CATT

Chair), Dr Angus McGregor (National Histopathology Training Schools Board Chair), members and deputies of the Histopathology CATT, Professor

Shelley Heard (current Director of Training and Educational Standards), Dr Hani Zakhour (immediate past Director of Training and Educational

Standards), Joanne Brinklow (Head of Educational Standards) and Sandra Dewar (Acting Head of Educational Standards/Assessment Manager).


29/123


APPENDIX 1 GENERAL HISTOPATHOLOGY CURRICULUM

The general histopathology curriculum outlines the training requirements for the award of the CCT in histopathology. A separate section describing

the expected content of Stage A/ST1 training precedes the curriculum for Stages BD.

All trainees are expected to undertake training in the basic knowledge and skills of histopathology. This includes surgical pathology, basic autopsy

(during stages A and B) and cytopathology (including cervical cytology in stages A and B and non-cervical cytology throughout training). The traineeshould also acquire the generic skills required for histopathology, in accordance with Good Medical Practice.

Trainees are also expected to have some exposure to forensic pathology, neuropathology and paediatric pathology as part of their general

histopathology training.

Expected training during Stage A/ST1 of training

There is no intention to use this appendix as a measure of aptitude or achievement. It is simply an indication of the range and level of experience that

could be reasonably expected of a trainee in Stage A. In serving as an indicator, the surgical pathology list should be interpreted in the light of

workload and case-mix in the training department. Surgical specimens considered routine in some departments, e.g. an oesophagectomy, would be

infrequent in others. Thus, its inclusion in the list does not mean that experience of this specimen type is mandatory, only that a Stage A trainee

should be familiar with the handling and reporting of similar major resection specimens from cancer cases. Naturally, some cancer specimens (e.g.

pancreatectomy or laryngectomy) are considered too complex for a Stage A trainee to dissect independently.

Some experience of specialised areas of pathology is also expected during Stage A and trainees should spend a short period of attachment to

neuropathology and paediatric pathology.

The level of knowledge gained within each of the areas described below will vary between trainees. However, for each disease process listed, it isrecommended that the trainee possesses at least a basic level of knowledge within the following eight categories.

Epidemiology

Aetiology

Pathogenesis Clinical features

Pathological features (macroscopic and microscopic)

Natural history

Management options

Major complications of therapy.


30/123


It is important that sufficient basic knowledge of major pathological processes is gained at this early stage. This should include topics such as: causes

of and responses to cellular injury, acute and chronic inflammation, neoplasia, the effects of genetics and the environment in health and disease,

infections and the basics of immunology.

Surgical pathology

System Macroscopic pathology Microscopy Knowledge baseGeneral Correctly identify patient details relevant

to each specimen

Correctly orientate specimens

Open fresh specimens

Correctly obtain fresh tissue for touchpreparation, freezing, electron microscopyetc.

Ink excision margins

Lymph node anatomy and dissection incancer specimens

Sets up a microscope correctly

Recognise normal histology and normalvariations of common tissue types

Select/identify appropriate histochemicalstains for glygogen, fat, mucins andamyloid

Familiarity with basicimmunohistochemical markers for majortissue and tumour types and interpretation

of a basic panel of immunohistochemicalmarkers on an undifferentiated tumour

Normal anatomy and histology

Pathological basis of disease

Common pathological abnormalities

Breast Mastectomy. Wide local excision formacroscopic tumour

Axillary lymph node dissection

Screening specimen for microcalcification

Diagnose invasive cancer on needlebiopsy

Report mastectomy or wide local excisionspecimens

Ductal carcinoma in situ, invasiveductal carcinoma, invasive lobularcarcinoma, fibrocystic change,fibroadenoma


31/123


System Macroscopic pathology Microscopy Knowledge base

Uppergastrointestinaltract

Radical oesophagectomy

Radical gastrectomy

Antrectomy

Recognise Helicobacter associatedgastritis; oesophageal and gastricmalignancy on biopsy

Report oesophageal and gastricmalignancy resection specimens

Helicobacterassociated gastritis,reactive gastritis, Barrettsoesophagus, oesophageal carcinoma,gastric carcinoma, coeliac disease,duodenitis

Lowergastrointestinaltract

Colectomy/proctectomy for cancer orinflammator

Histopathology Curriculum Ar

Documents

Transcript of Histopathology Curriculum Ar